WASHINGTON -- The healthcare reform law received cheers in one room and boos in another at a hotel here Tuesday.

WASHINGTON -- Opposing forces often operate in close quarters here, but that was especially clear on Tuesday in Washington's Grand Hyatt Hotel.

In one of the hotel's conference rooms, a group of conservative health policy wonks held a seminar entitled "The Next Chapter in the Health Reform Debate." Talking about the Affordable Care Act, Rep. Michael Burgess, MD, (R-Texas) yelled, "We have to repeal this dog!"

One floor down in the same hotel, Centers for Medicare and Medicaid (CMS) Administrator Donald Berwick, MD, was giving a crowd of nurses the exact opposite message. "The Affordable Care Act is actually a stunning bill. It's a terrific piece of legislation," he gushed to the group, which was gathered here for a summit sponsored by the Institute of Medicine.

At the upstairs event, sponsored by the Galen Institute, American Action Forum, and the Institute for Policy Innovation, the crowd of several dozen heard from state and federal politicians about going forward with reform implementation.

One of the speakers, Sen. Ron Wyden of Oregon, a Democrat, touted his new bill, co-sponsored by Sen. Scott Brown (R-Mass). Brown's surprise election to the Senate in January lost Democrats their filibuster-proof majority and forced them into changing their strategy to pass the Affordable Care Act.

Together, Wyden and Brown sponsored a bill that would allow states to opt out of participating in the Affordable Care Act (ACA). The law actually already allows states to opt out, beginning in 2017, but the Wyden/Brown bill would move that date to 2014. States can only opt out if they can prove that they have another way to provide health insurance coverage to as many state residents as would receive it under the ACA.

Wyden said that most Americans do feel the healthcare system needs to be reformed.

Burgess, who spoke after Wyden, seemed to agree, but said the reform should not come from the ACA, which he said needs to be scrapped.

"It will eventually cause the collapse of the American medical system," Burgess said of the law.

Meanwhile, Berwick was downstairs touting the ACA's benefits to the nurses.

"It provides security for the chronically ill. It allows people to buy medications who couldn't have afforded them before," he said. "It seems weird to me that the American public doesn't seem to understand how good this could be."

Upstairs, Burgess also addressed the more immediately pressing issue for doctors: the sustainable growth rate (SGR), the Medicare formula that calls for cuts in doctor pay year after year. On Monday, the House passed a one-month patch to stall the 23% cut in physician payments under Medicare scheduled to take effect on Dec. 1.

But come Jan. 1, doctors face an even larger cut -- Burgess placed it around a 26% reduction compared with current Medicare reimbursement levels. The 112th Congress won't be seated until Jan. 5, however, so doctors may be billed by CMS at the lower rate at least for the beginning of January, Burgess predicted.

As for a more permanent fix for the SGR, Burgess told reporters that such a bill needs to come from congressional leadership, and not a "rank and file" member such as himself.

A longer-term SGR fix bill would need to be offset, which means some "pay-fors" -- savings to "pay for" the bill -- will have to be found.

"They are out there, and they are all painful," he said.

Burgess also laid out a hypothetical measure: combining a repeal of the ACA's individual mandate provision -- which is strongly opposed by Republicans -- with a permanent repeal of the SGR.

But given that Democrats will still control the Senate in the next Congress, most health policy experts and politicians agree that a repeal of the mandate -- one of the major underpinnings of the ACA -- is unlikely.

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